Coding & Billing Tips

Hernia Codes

Don’t forget to use the following new premature hernia codes. Remember to document postconceptional age in the operative note to minimize payment delay due to auditing of this code by payers.

49491 Repair, initial inguinal hernia, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 50 weeks postconceptional age, with or without hydrocelectomy; reducible. Total RVUs (17.74) Using typical conversion factor of 36.7856 = $652.58

49492 Repair, initial inguinal hernia, preterm infant (less than 37 weeks gestation at birth), performed from birth up to 50 weeks postconceptional age, with or without hydrocelectomy; incarcerated or strangulated. Total RVUs (21.78) = $801.19

49495 Repair, initial inguinal hernia, full-term infant under age 6 months, or preterm infant over 50 weeks postconceptional age and under age 6 months at the time of surgery, with or without hydrocelectomy; reducible. Total RVUs (9.95) = $366.02

49496 Repair, initial inguinal hernia, full-term infant under age 6 months, or preterm infant over 50 weeks postconception age and under age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated. Total RVUs (15.820) = $581.95


Pediatric Critical Care Codes

There are two new pediatric critical care codes for children 2 years old and younger that are based on the neonatal critical care codes format that includes all the critical care personally provided by a physician in a day. You can simply bill these codes once a day and they include all the care provided for the day including placement of central lines, ventilator management, etc. They do not require documentation of total hours at bedside but they are inclusive meaning that two different services cannot bill these codes on the same day of service. Use the following codes for billing for critical care:

99293 Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child. Total RVUs (21.83) = $803

99294 Subsequent pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child. Total RVUs (10.8) = $397.28

The American Pediatric Surgery Managers Association (APSMA) is also a good practice resource.